M Weiss & Associates, PC

1-800-424-2233

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I got hurt in a car accident.

For a FREE no-risk evaluation of your potential claim, please answer a few questions.

Any other area that you hurt?

Where are you hurt?HeadNeckShoulderBackArmHandKneeLegFoot

Your Name (required)

Your Email

Phone (required)

Date of Accident

Town and City of Accident

Did you go to the hospital?YESNO

Do you currently have a lawyer?YESNO

Do you have a Police Report?YESNO

Please be aware that in submitting this form you are not retaining legal services from any law firm. The information requested in the above form are the minimum facts needed for any attorney to begin to evaluate your claim. Additional information may be needed to complete your free claim evaluation.